Changing the Conversation About Perinatal Mood Disorders

23 August 2024 — CAPE COD, MA — New parents struggling with perinatal mood disorders during pregnancy or after the birth of a child are far from alone, but fear, judgement, and impossible standards keep people from seeking help, and a lack of certified health practitioners makes it even more difficult for Cape parents to find it. Efforts have begun to train professionals and change the conversation from shame to support.

What are perinatal mood disorders?

Sixteen years ago Liz Cable in Brewster, mother of three and co-owner of Rising Tide Doulas And Lactation, found out she was expecting twins. With that news the pregnancy turned high risk, fear of complications and twin transfusion syndrome, Liz and her ex-husband went from regular midwife check-ins to maternal fetal medicine appointments several times a week. Her babies, two boys, were born prematurely and were placed at the Neonatal Intensive Care Unit. “It was just a really hard way to enter into parenthood, you know?” Liz says. She describes the NICU experience as traumatic – her babies had severe respiratory distress, she was not allowed to hold them and she almost lost one of them. She would eventually get therapy to work through the experience a couple of years later. The therapist mistreated it as post-traumatic stress disorder, when in fact the intrusive thoughts and anxiety Liz was experiencing was a perinatal mood disorder.

How common is postpartum depression?

Liz and her babies left NICU but due to the twins’ compromised immune systems they were not allowed visitors at home, leading to what Liz calls “a deeply isolating experience.” Furthermore, breastfeeding was extremely painful, “I had infection after infection. I got misdiagnosed a lot, several times,” Liz says. The twins were treated for thrush, which “wasn’t the problem. It turned out to be a bacterial infection, and they finally treated that,” Liz says. But it was not until she found a lactation consultant that Liz could breastfeed without pain. “She was like, ‘oh they’re not latching properly’. And then it was fine after that.” Having such a simple solution be as inaccessible as it had been for Liz made her see how having the right support can make a world of a difference. “I’ll never forget her. She saved me,” Liz says.

Why is perinatal mental health misdiagnosed?

It was easier to connect with her babies when breastfeeding fell into place, but Liz still did not know that the intrusive thoughts, the anger and the anxiety she was experiencing were signs of something bigger than her, something treatable. At night she was awake ruminating “feeling like something was gonna happen to the babies,” she recalls. “or maybe I was just a bad mom and I didn’t deserve them.” Because of the taboo topic – not connecting with your newborn, having vivid images of death or injury coming to your children, not being encompassed with complete joy, quite the opposite – Liz suffered in silence. “I was afraid to talk about it because of the stigma around it,” she says.

What are the symptoms of perinatal mood disorders?

Liz is far from alone in being misdiagnosed. The stigma and the shortage of professionals certified in perinatal mental health are making new parents even more vulnerable and alone. Postpartum Support International is training health professionals to be able to spot and treat perinatal mood disorders. One in five birthing parents and one in ten male parents will experience perinatal mood disorders, but only 25 percent of everyone seeking help gets treatment. Though there are more screenings in postpartum medical check-ups, Christina Raines, Board Chair Emeritus at PSI, says a practitioner not certified in perinatal mental health could react to the symptoms in a negative way, adding further to the stigma continuing to move in a negative spiral. In fact, 80 percent of all birthing persons will experience the so called baby blues, tearfulness and irritability, but when it persists longer than two weeks, it has moved into a perinatal mood disorder and can be treated. On Cape Cod, the Perinatal Wellness Support Center is offering two scholarships per year for those wishing to attend a PSI training.

What are intrusive thoughts?

The intrusive thoughts is a common symptom, Reines points out that intrusive thoughts are not synonymous with psychosis, and likens intrusive thoughts with driving behind a log truck imagining the logs flying off the truck and through your car window. “A lot of moms will see the baby in the microwave, thinking about putting the baby in the oven. One of the most common ones is seeing the baby falling down the stairs,” Reines says. “Visualizing the baby with knives, that can be really frightening and not being able to express that causes that anxiety to increase your cortisol which increases your anxiety which then affects breastfeeding and the bonding. It’s really a catch 22.” Research about intrusive thoughts centers around the birthing parent being a good parent having a defense system gone awry.

Where can I get help?

“Everybody is afraid of mental health,” Raines says regarding the stigma. “That involves motherhood which we hold on a pedestal.” She adds, “You're not broken. You’re not crazy. There is hope. There is treatment. This is a time-limited illness that you can heal and get better from. And every woman deserves to enjoy their pregnancy and their postpartum."

Call the PSI HelpLine: 1-800-944-4773
#1 En Español or #2 English

Text “Help” to 800-944-4773 (EN)
Text en Español: 971-203-7773

National Maternal Mental Health Hotline: 1-833-TLC-MAMA